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What if Your Doc Says Your Labs Are Normal…But You're Still Not Getting Pregnant? · Nourished Fertility

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  Welcome back y'all to the Nourishing Women Podcast, your go-to podcast to
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  get your period back and get pregnant.
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  I'm your host, Victoria Myers, peer recovery specialist, fertility,
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  dietician, and owner of the virtual coaching practice, nourishing
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  Mind Nutrition, where we work together to restore your fertility.
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  Today we're going to dig into a topic I hear all the time from new
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  clients you're trying to get pregnant.
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  You haven't had a period in months.
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  Maybe years even, and you go to your doctor hoping for clarity, they run a
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  bunch of labs, and what do you hear?
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  Everything looks normal.
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  Just keep doing what you're doing.
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  Or maybe you get, you seem so healthy, you know, it could be unexplained infertility.
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  They may even shrug their shoulders and say, I have no idea.
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  It's PUS.
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  Maybe I like, I don't know what's going on, and I lovingly but
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  firmly what to call BS on that.
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  Let's talk today about why quote unquote, normal labs don't always mean that things
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  are functioning optimally and without.
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  Really means for your fertility.
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  Because if you're being told your labs are normal and yet you don't have a period,
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  I mean major red flag, your period is your fifth vital sign, but maybe you
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  do even have a period, but it's very light and very unpredictable, and you're
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  pretty sure that you're not ovulating.
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  You know the pks never turned positive, and you don't have fertile cervical mucus
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  or a rise in your BA basal by temperature.
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  You could even have ovulatory cycles.
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  You are getting confirmation of ovulation, but they are wildly unpredictable.
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  You know, they're 45, 60, 90 plus days long.
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  You may have signs of low progesterone like you are ovulating and cycling, but
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  you're having very short luteal phases, which is anything less than 11 days.
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  Or maybe even horrible PMS, which again points to low progesterone.
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  You're cold 24 7, you're waking up in the middle of the night, drench and sweat.
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  You pee all the time.
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  You never go to the bathroom though.
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  You've got daily headaches.
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  Your sex drive is non-existent, which by the way, that part like
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  sucks and no one talks about that.
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  We should have a podcast episode just on that solely because when you're trying
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  to conceive what is like the number one thing you need to do is have sex.
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  So, just, just a side note there.
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  And I also bet if all of these kind of describe a situation that you're
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  currently in, I bet too, you're tracking every bite that you eat.
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  You're obsessing over food, and you're working out to earn carbs.
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  Does this sound familiar to you?
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  If that's your experience, let me just say this.
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  I don't care what the lab sheet says.
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  If they're not optimal, they're not fertile.
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  By the end of today's episode, you are going to understand which specific
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  blood labs matter for period loss and why, and what's normal versus not so.
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  Here's what your labs might say and what they actually mean for fertility.
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  Let's dig in, shall we?
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  We're gonna start first with FSH or follicle stimulating hormone.
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  This is produced by the pituitary gland and FSH helps stimulate the
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  growth of ovarian follicles in the first half of your cycle, you can think
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  of FSH as like the egg prep hormone.
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  It gets that follicles ready to potentially release an egg anywhere.
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  From three to 12 international units per liter is considered normal.
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  And if you have peered loss from hypothalamic amenorrhea, which is the
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  focus of our practice in this very podcast, you are typically either gonna
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  see low to low normal with HA clients.
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  You'll hear me share a lot in this episode.
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  Low normal because that's the lower end of normal.
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  And as it sounds, duh.
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  Um, but that's why a lot of this often goes missing because the doctor
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  will say, Hey, that's in range.
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  But if they're all the low normal, again, that's not normal at all.
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  And just because it's still within range does not mean it's optimal for fertility.
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  FSH is really important.
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  By the way.
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  It is one of the three most often used labs to diagnose officially hypothermic
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  amenorrhea as they consistently emphasize here on the show though.
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  And it's pretty rare to get a formal diagnosis of ha and that's okay if
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  you can't get a formal diagnosis.
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  I don't think that means that you shouldn't move forward
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  with peer recovery work.
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  In fact, I would say like that shouldn't be, um, the make or break in any way.
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  But if you do get a diagnosis or you are going to a doctor for fertility
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  and you do get an FSH, you are looking for that low to low normal.
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  FSH is also important in context to luteinizing hormone or lh, which
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  we'll talk about next, especially if we're trying to rule out PCOS.
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  I'll explain why here in a second.
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  And also worth staying here.
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  FSH is also helpful to see because if we see extremely high numbers, this could
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  be potentially sign a diminished ovarian reserve or potentially even premature
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  ovarian insufficiency, which would mean more investigation needs to be done either
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  into your thyroid, to your functional labs that need to be examined or even could be
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  occurring from a very, very long period.
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  Maybe a very strong history of an eating disorder.
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  Having under fueling, over exercising diminished ovarian reserve is obviously
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  a little bit more complex and one of the many reasons to work with a peer
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  recovery specialist to understand better what's going on if that is you.
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  But again, another reason why FSH is so helpful to see.
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  Up next is LH or Luteinizing hormone.
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  This is also made by the pituitary gland.
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  LH surges mid cycle and triggers ovulation.
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  The actual release of the egg, it is your like go signal for ovulation.
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  Actually, without this surge of lh, no egg gets released.
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  Therefore, no chance for pregnancy.
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  That specific cycle.
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  What's considered normal for LH is anywhere from two to
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  like 12 international units.
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  Per liter in the folic phase.
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  And what your doctor probably is looking for is what, you know, we,
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  we consider classic hypo hemic.
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  Inter ary, which is anything below two.
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  Although I see with our clients a lot, again, that low normal range, just as
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  I referenced with FSH, and that would specifically be anything below 10.
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  Having LH and FSH can be helpful to roll out.
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  PCUS.
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  I just mentioned that.
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  So let's dig into that.
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  If LH is much higher than FSH, like a two to one or three to one
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  ratio, this can point us more to A-P-C-U-S case of period loss.
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  Keep in mind too, though, and this is where things get tricky, and I'm gonna
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  say this over and over in this podcast episode, but working with a peer recovery
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  specialist is just so important because.
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  In the process of peer recovery, what can happen is that the LH
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  can overshoot production as it learns how to work effectively.
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  Again, and if this happens as you are like in the midst of peer recovery, a
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  second lab repeat can be helpful to either help confirm or deny that your elevated
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  LH is from PCOS or not so that is lh.
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  Let's go next.
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  The third most common lab ordered for hypothermic.
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  Amenorrhea.
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  And really we have to have these three.
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  If we are trying to confirm hypothermic, amenorrhea, uh, and this is estrogen.
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  This is probably the.
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  The biggest, most important one I would argue, although I think all of these
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  are important, but estrogen is very, very important, um, to both order,
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  and also of course for your body.
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  It is made primarily by developing follicles, but it's also made by the
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  adrenal glands and fat cells too.
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  Estrogen plays so many important roles in the body, so much so that
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  we should poly record a podcast episode solely on that topic alone.
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  But for reproduction specifically, it plays a very important role
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  in thickening the uterine lining.
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  Boosting cervical mucus prepping the body for ovulation.
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  You have to have enough estrogen to tell your body to have that surge of
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  lh that therefore leads to ovulation.
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  And estrogen is your primary hormone in the filer phase.
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  Normal is considered anywhere from about 20 to one 50, um, and we consider estrogen
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  deficiency in a case of hypothermic amenorrhea if it's anything below 50.
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  So as you can see, again, it is within that, that quote unquote normal.
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  Range but below 50, especially when you are doing this in your
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  follicular phase, is a major concern.
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  Um, and again, pointing us to your period loss is caused from low
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  or suboptimal levels of estrogen.
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  A classic or more severe case, if we want to call it that, of ha, is typically
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  gonna be lab values of estrogen of like between 20 or 30 or even lower.
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  I've seen as low as three and four before.
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  So again, a more classic case of ha, which is what your Dr. May be looking
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  for, is gonna be extremely low estrogen.
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  But anything below 50 is an estrogen deficiency and.
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  Maybe also pointing you towards that spectrum of ha that we've discussed
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  here on the podcast before, right?
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  Where maybe you don't have a entirely missing period, but
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  it's wildly unpredictable.
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  You're having an atory bleeds, you're having short luteal phases.
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  You aren't having a normal cycle.
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  That's what we consider the spectrum of ha.
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  If your estrogen is high, normal to high, this may point us to
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  A-P-C-O-S case of pure loss instead.
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  . And again, another great example of why we wanna see labs like estrogen.
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  'cause it can really help us clearly define what's specifically
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  going on in your peer loss case.
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  And as you can see, what is diagnosable as HA specifically is more often
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  than not still in the normal range.
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  This is why working with a peer recovery specialist and.
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  Expert in this area as well as taking labs as only one piece of
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  the diagnostic toolkit is important when it comes to peer loss from ha.
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  We just have to consider both habits and history just as much as
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  we consider the labs and the data.
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  With that shared, let's keep going.
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  Let's talk next about progesterone.
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  This is produced after ovulation.
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  It is your dominant hormone in the luteal phase, and it's
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  produced by the corpus ludia.
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  The leftover follicle after the egg is released in the event of ovulation,
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  progesterone stabilizes the uterine lining and supports early pregnancy.
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  It's also your calming, soothing hormone that helps with sleep, reducing
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  inflammation, keeping the uterine lining intact for implantation.
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  We don't, in the case of HA specifically, use progesterone as a diagnostic criteria,
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  and the reason for that is if you aren't ovulating, we just know that you're gonna
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  have an incredibly low progesterone, like that's not gonna be produced by the
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  body if there's no ovulation happening.
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  Now, if you are in the midst of peer recovery, you've already had
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  some cycles but we're still having wonky cycles or wonky issues.
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  Um, mainly you're, you're not getting pregnant as quickly as
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  we'd ideally want you to be.
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  That's when I personally wanna see progesterone.
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  We would do this five to seven days after ovulation, and I think that's a really
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  important note to make about progesterone because all these other labs are more
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  often than not gonna be ordered either day three or day four of your cycle.
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  Again, with progesterone, we wanna order it in the second half of your cycle,
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  five to seven days after ovulation to accurately see the picture of how much
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  progesterone your body is creating.
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  And that's true for both.
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  Um, a functional lab test like a Dutch complete or with doing a
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  sex hormone panel with your doctor at, you know, an OB GYN office.
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  What I'll also say is in our practice we actually most commonly use basal
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  by temperature to help us assess progesterone with our clients.
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  A healthy elevation in basal body temperature, all through the
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  luteal phase with the gradual drop.
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  Right before your period begins, gives us a lot of insight into what's going
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  on with your progesterone levels, and if that's, if we're not having that
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  healthy elevation in that gradual drop, that indicates something could
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  be going on with your progesterone.
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  Okay, up next A MH or anti malian hormone, I thought this was really
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  important to address because this may be the very hormone drawn that
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  made your doctor go like, Hey.
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  Your best bet is I-V-F-A-M-H is secreted by tiny follicles in the ovaries,
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  and a MH reflects your egg reserve match to your age related peers.
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  What's considered normal from a MH is anywhere from one to
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  four nanograms per milliliter.
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  But here's the kicker and why I wanted to mention it today.
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  If you aren't ovulating, a MH will appear low because your
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  follicles aren't maturing.
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  This doesn't mean you're infertile or you need IVF to get pregnant.
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  It means instead you need to recover your period.
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  In complete contrast to that, in pure loss from ha, it could also
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  appear as too high, which is often why women with pure loss from HA can
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  mistakenly get diagnosed with PCOS.
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  In these cases, this may happen because there are many follicles, but
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  none are maturing enough to become.
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  The dominant follicle that reaches ovulation.
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  In fact, I'm working right now with a client that has HA and a significant
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  history of an eating disorder in her past, still obviously under eating,
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  yet she has a really high A MH and was misdiagnosed with PCOS because of this.
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  This is why working with a specialist impaired loss is so important because
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  had she listened to the doctor's advice here, she would probably have gone on a
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  low carb diet, which is like truly, truly like the last thing this client needed.
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  When discussing A MH.
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  It's also important to mention here that if you have a period and still
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  have very low A MH, you should test your vitamin D levels as low Vitamin D can
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  affect A MH levels and in addition to potentially supplementing with vitamin
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  D to raise am MH, what you eat and your lifestyle can also help raise am
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  MH again, in the case of you actually having a period, but still low am MH.
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  If this is you I'd, I would highly recommend the Nurse Body four fertility
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  series here on the podcast as we discussed in that series, a lot of fertility
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  friendly foods and supplements that we can consume to help raise those A MH levels.
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  By the way, I just mentioned vitamin D and this specific episode is
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  talking specifically about, you know, what's normal versus not
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  for, um, hormones specifically.
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  While vitamin D is technically a hormone, I'm gonna consider it more for the
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  context of this episode in the vitamin category, and we should certainly have
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  an episode in the future specific to what vitamins to order and what to look
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  at with that in mind, when it comes to fertility today, we're just gonna
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  focus on like a sex hormone panel.
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  Okay?
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  Up next prolactin.
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  It is important to talk about prolactin because this hormone
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  can mess with your period.
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  Two Prolactin is most commonly known for its role in breastfeeding, right?
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  However, we can also have elevated prolactin levels called
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  hyperprolactinemia, which can actually suppress your brain's reproductive hormone
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  signaling and affect then your period.
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  What's normal for prolactin?
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  Most labs will say anything below 25 nanograms per milliliter.
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  Uh, but if you're seeing results closer to 30 or above, especially if you have
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  no period, I would dig deeper here.
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  I would also consider to, especially if we're talking about like
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  significantly elevated prolactin levels.
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  We're talking like a hundred and above.
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  That's when we potentially wanna consider Prolactinoma, which is
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  a small, usually benign pituitary tumor that can cause pure loss.
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  Two and if in that case, if your prolactin was extremely elevated, that would cue
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  to us and to your doctor specifically.
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  This is when we would refer to a doctor to get a brain MRI, to rule that out.
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  If it we're talking just mildly elevated, that could be due to
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  stress, thyroid dysfunction, sleep disruption, or even certain medications.
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  The bottom line with prolactin is if it's elevated, that's not something to
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  ignore or something to get curious about.
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  It might be HA or it might be something else.
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  And again, why working with a peer recovery specialist can help so much
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  because we can adjust the plan as needed.
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  Speaking of the thyroid, let's talk about TSH or thyroid stimulating.
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  Hormone.
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  This is actually not made by the thyroid, but by the pituitary gland.
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  And TSH tells your thyroid to produce T three and T four.
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  The vary hormones that control metabolism, energy levels, and body temperature.
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  Low thyroid function, even subclinical can disrupt ovulation, shorten luteal phase,
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  it can increase the risk of miscarriage and lower progesterone production.
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  So this is an important lab to order.
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  I find it can be really difficult with doctors to get them to order
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  anything other than a TSH, but if you can, you really ideally wanna
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  get instead a full thorough panel.
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  And this is something we'll order with our clients when needed and a full
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  thyroid panel is not only TSH, but also free T four, free T three total
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  T three, reverse T three, and your thyroid antibodies with TSH anywhere
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  from 0.5 to 4.5 is considered normal.
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  But what's optimal, and this is a biggie for TSH specifically, is
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  between one and two higher, TSH, even within range can suppress ovulation
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  and increase miscarriage risk, but especially, especially points us if
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  it's above two, that something is going on with your thyroid, which
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  sometimes for us means that we need to refer out to a doctor for medication.
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  Some tests, that means that we just need to do some more functional lab testing.
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  It truly depends on the case and the situation, but I wouldn't wait for
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  your labs to get with TSH in mind to, you know, above 4.5 to address it.
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  If it's getting higher than two, we need to look at that and see what's
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  going on there, and that's when a full third panel especially is needed.
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  So while FSH, LH and estrogen are the most important hormones to consider
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  when we're ruling out, um, or confirming hypothermic amenorrhea, or that your peer
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  loss is caused from an energy imbalance within your body, there's obviously
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  a lot of other labs that you can look at to either confirm or deny that too.
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  Since misdiagnosis of PCOS is so common when it comes to ha.
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  If you are trying to rule that out, I would also highly consider
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  talking about with your doctor too, ordering or having someone like a
• 17:53
  dietician order your lap for you.
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  Ordering, specifically testosterone, fasting, testosterone, sex
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  hormone binding globulin,
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  d-H-E-A-S, insulin and fasting glucose and within all these labs, but especially
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  with F-S-H-L-H and estrogen, if your labs come back, quote unquote normal,
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  but you still have a missing period and you're struggling to conceive now you
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  know what you're really looking for here.
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  And a lot of these labs were on that low normal side, right?
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  But that doesn't mean that they are in fact normal.
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  They are nowhere near.
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  Optimal for fertility.
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  And if this is you and you're struggling to get pregnant, what's next?
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  What you don't need to do is throw money at treatments for unexplained infertility.
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  You instead.
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  You need to restore nourishment, proper rest, the right macro and
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  micronutrients to support estrogen production as well as the other key
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  hormones involved that are currently low or suboptimal and bring back ovulation.
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  And that's exactly what we do inside of Premier peer recovery for fertility.
• 18:53
  We've helped hundreds of women just like you, restore their cycles, get
• 18:57
  their bodies ovulating naturally and conceive without drugs,
• 19:01
  invasive procedures, or guesswork.
• 19:04
  You are not a medical mystery.
• 19:05
  You are not unexplained.
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  You are not.
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  Oh, your labs are normal.
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  Just keep doing what you're doing and maybe you'll need IVF down the
• 19:11
  road, or you need it right now.
• 19:14
  Your body just needs enough energy and safety to do what it was built to.
• 19:20
  Do.
• 19:21
  Let's ditch the gas lighting, decode your labs for real, and
• 19:24
  get you pregnant naturally.
• 19:25
  If this is you, when you're ready for next steps, you can apply for
• 19:28
  one oh one decision making call with me and we'll chat via Zoom
• 19:33
  and see if it's a good mutual fit.
• 19:34
  The application is included in the show notes.
• 19:36
  Thank you so much for listening to this episode.
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  I hope you got so much out of it.
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  Hey, if you have a friend who's also struggling right now with fertility.
• 19:43
  Go share this episode with them.
• 19:45
  I'm positive they'll get so much out of it too.
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  We'll be back, as always for another episode next week.
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  Until then, know that a nourish spotting is a powerful one.